Individual
KELLY L MAUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
5800 FAIRFIELD AVE STE 150, FORT WAYNE, IN 46807-3450
(260) 744-5585
(260) 744-5586
Mailing address
5800 FAIRFIELD AVE STE 150, FORT WAYNE, IN 46807-3450
(260) 744-5585
(260) 744-5586
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05001649A
IN
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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